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Does health insurance cover Bariatric Surgery?

Team AckoJan 17, 2024

Due to lifestyle choices, obesity is on the rise in India and the world. Excessive body weight could cause a myriad of health complications. Some of these conditions can even be critical.

Thus, undergoing Bariatric Surgery may be an urgent necessity for some. The costs of undergoing Bariatric procedures could amount to a lot. If you are wondering if your health insurance plan that covers Bariatric Surgery, you are on the right page! Read ahead to find out.

Contents

What is Bariatric Surgery?
Does health insurance cover Bariatric Surgery?
Frequently asked questions

What is Bariatric Surgery?

Bariatric Surgery usually refers to weight-loss procedures that require an operation. These procedures are aimed at changing the digestive system to facilitate weight loss. Some procedures may restrict how much you can eat, while others may limit the amount of nutrients your body can absorb. These surgeries are usually only prescribed after diet and exercise have failed to show satisfactory results.

Types of Bariatric Surgery

Various types of procedures are referred to as Bariatric Surgery. Below are some of the common ones.

Sleeve Gastrectomy
Mini Gastric Bypass
Metabolic Surgery
Adjustable Gastric Banding
Reduced Port Surgery
The Roux-en-Y Gastric Bypass

How much does Bariatric Surgery cost?

The basic cost for availing of Bariatric Surgery may be anywhere around Rs. 2.5 lakhs to Rs. 5 lakhs. However, the exact price may differ from one hospital to another. Besides the procedure cost, post-surgery, you may need to consult a dietician to adapt to your new lifestyle. These sessions may cost you additionally.

What will occur if Bariatric Surgery is delayed?

If Bariatric Surgery is not undergone on time it may cause further health complications. Below are some of the consequences of delaying the procedure.

Hypertension may develop
Heart health may decline
May induce type 2 diabetes
Increase in blood pressure
Cholesterol levels may also increase
Sleeping disorders may ensue

Does health insurance cover Bariatric Surgery?

Since the cost of availing Bariatric Surgery is on the higher side, you may be wondering if it is covered under health insurance. Fortunately, as per the guidelines put forth by IRDAI (Insurance Regulatory and Development Authority of India) in 2019, Bariatric Surgery is included in health insurance. Thus, it is usually mentioned as an inclusion under most health insurance policies. Nevertheless, refer to the policy wordings of your health insurance to find out if it is an inclusion.

Criteria for availing coverage for Bariatric Surgery under health insurance

Health insurance may cover Bariatric Surgery only if the following criteria are met.

You must be at least 18 years of age while undergoing the surgery.
Your Body Mass Index (BMI) value must be 40 or above.
Your BMI is 35 or above and you suffer from comorbidities like diabetes, heart disease or stroke.
You must possess the doctor’s prescription and relevant diagnostic test result reports.

Documents needed to raise a claim for Bariatric Surgery

In order to raise a claim for Bariatric Surgery, you may need to produce the following documents to your insurer.

Medical reports indicating a history of suffering from obesity-induced health problems.
Evidence of undergoing dietary and lifestyle changes for the purpose of weight loss.
Proof of unsuccessful attempts at weight loss while undergoing pharmacological therapy (if applicable).

Waiting period for Bariatric Surgery under health insurance

In health insurance, the waiting period refers to a duration during which you cannot raise claims for health conditions. Most health insurance plans usually have an initial waiting period of around 30 days immediately after the purchase of the plan. In addition to that, if you have any pre-existing conditions, you may also have to serve another waiting period of around 2 to 4 years.

Fortunately, under ACKO Health Insurance Policy, there is no initial waiting period when you buy the policy. You can raise claims as soon as you purchase the plan. Also, even if you suffer from any pre-existing health conditions, you do need to serve any waiting period. However, this is applicable only if you report these conditions to us at the time of buying the policy.

Learn more about waiting period for health insurance.

Exclusions under health insurance for Bariatric Surgery

The following are the usual exclusions for Bariatric Surgeries under health insurance. Nonetheless, go through the policy wordings of a plan to find out its exact inclusions and exclusions.

As mentioned earlier, claims cannot be raised during the initial waiting period of a plan. This period may last around 30 days.
In some cases, health insurance doesn’t cover Bariatric Surgery if it is for a pre-existing condition.
If a plan does cover pre-existing conditions, these conditions may be covered only after a waiting period of 2 to 4 years.
If surgery is being undertaken for cosmetic or aesthetic reasons, it may not be covered under a health insurance plan.
Also, if the weight gain is a byproduct of medication or poor mental health, the surgery for the same may not be covered.

To sum up

Obesity is on the rise in India. Thus, its related health complications are also increasing. Since conventional weight-loss practices don’t always work, Bariatric surgery becomes the only resort. However, these procedures and the consequent post-surgery expenses can amount to a lot. That is why we recommend that you purchase a health insurance plan that covers Bariatric Surgery with minimum exclusions. That way, your financial burden will be lifted off of you and you may feel as though you weigh less.

Frequently asked questions

The following are some of the frequently asked questions regarding Bariatric Surgery coverage under health insurance.

Will I still receive coverage for Bariatric Surgery if I port my health insurance?

Yes, you can receive coverage for Bariatric Surgery if you port to a new plan. But, this is only provided the new plan also offers financial support against Bariatric Surgery. Nonetheless, you will be subject to a fresh waiting period if applicable under the new plan.

Does any extra payment need to be made to receive coverage for Bariatric Surgeries under health insurance?

Some health insurance policies may not cover Bariatric Surgeries under their base plan. However, they may offer this coverage as an add-on for a little extra premium. Thus, it is important to check this with your insurer before buying a plan.

What is the ideal sum insured required to manage expenses for Bariatric Surgeries?

Since Bariatric Surgeries can cost anywhere between Rs. 2.5 lakhs to Rs. 5 lakhs, you may need a sum insured of at least Rs. 5 lakhs. But, you must also consider the expenses of post-surgery support you may require like nutritional advice from a dietician and other lifestyle change-related costs.

That is why we recommend that you consider buying ACKO Health Insurance Policy. Under this plan, you will be covered under a sum insured amount of Rs. 1 crore. Since the sum insured is high, you may be able to fit all your medical expenses under it. This may help you shift your focus from managing funds to getting better.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.